Neuroleptic Malignant Syndrome
Neuroleptic malignant syndrome (NMS) overview
Life-threatening condition caused by antipsychotic medications, including the new generation antipsychotic medications.
Reported in patients on tricyclic antidepressants.
Also seen in patients who are rapidly withdrawn from dopamine agonists such as antiparkinsonian medications.
Generally occurs during the first week to a month on the treatment, although it can develop at any time during treatment.
Typically takes 1 to 3 days to develop fully.
May last from a few hours to a few weeks.
It can be fatal.
Risk factors
High-potency antipsychotic
High-dose antipsychotic
Prior NMS
Rapid dose increase
Age younger than 40 years
Males
Dehydration, malnutrition
Criteria for the diagnosis of NMS
Hyperthermia—oral temperature of at least 38 ° C in the absence of other causes of fever
Muscle rigidity, which is generally of the lead pipe type, although it can also be of the cogwheel variety.
Several of the following:
Altered mental status—altered sensorium, confusion, disorientation, stupor, coma
Autonomic instability—increased pulse, increased respiration, increased systolic and/or diastolic blood pressure, diaphoresis, urinary incontinence
Extrapyramidal symptoms—resting tremor, oculogyric crisis, choreiform movements, flexor-extensor posturing, festinating gait, sialorrhea, dysphagia
Laboratory abnormal findings:
Elevated creatinine kinase levels (” class=LK href=”javascript:void(0)” target=right xpath=”/CT{06b9ee1beed59419a81e5e1e1a4f60b0cc8cd1057525de73425b2b43f4df7f1b65ad1634b6fd3c73d10b41c555d0a387}/ID(AB1-M10)”>>1, 000 IU/mL) due to extreme muscle rigidity and contractility
Leukocytosis (” class=LK href=”javascript:void(0)” target=right xpath=”/CT{06b9ee1beed59419a81e5e1e1a4f60b0cc8cd1057525de73425b2b43f4df7f1b65ad1634b6fd3c73d10b41c555d0a387}/ID(AB1-M10)”>>15,000 white cells/mm3)Related posts:
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
